Basic Information
Provider Information
NPI: 1497904205
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: PATIL
FirstName: NILESH
MiddleName: N
NamePrefix: DR.
NameSuffix:  
Credential: M.D
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 636256 CENTRAL CREDENTIALING
Address2:  
City: CINCINNATI
State: OH
PostalCode: 452636256
CountryCode: US
TelephoneNumber: 5135855506
FaxNumber: 5135855511
Practice Location
Address1: 234 GOODMAN ST
Address2:  
City: CINCINNATI
State: OH
PostalCode: 452192364
CountryCode: US
TelephoneNumber: 5135844318
FaxNumber: 5135843020
Other Information
ProviderEnumerationDate: 09/17/2008
LastUpdateDate: 03/14/2018
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
208800000X4301093216MIN Allopathic & Osteopathic PhysiciansUrology 
208800000X35.096397OHY Allopathic & Osteopathic PhysiciansUrology 

No ID Information.


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